Awake Unilateral Biportal Endoscopic Decompression Under Local Anesthesia for Degenerative Lumbar Spinal Stenosis in the Elderly: A Feasibility Study with Technique Note

Figures & data

Figure 1 (A) Ropivacaine is injected into the epidural space using a spinal needle. (B) Dural sac and nerve root after decompression. LF, ligamentum flavum; NR, nerve root.

Table 1 Patient Demographic and Clinical Characteristics

Characteristics	Value
Age (year)	74.09±6.93
Sex, male (n)	13 (41.9)
BMI (kg/m²)	23.80±5.71
ASA classification (n)
II	7 (22.6)
III	24 (77.4)
Level involved (n)
L2-3	2 (6.5)
L3-4	8 (16.1)
L4-5	16 (51.6)
L5-S1	9 (25.8)
Levels of decompression (n)
One	27 (87.1)
Two	4 (12.9)
Follow-up time (month)	16.46 ± 3.19

Note: Values are presented as number (%) or mean ± standard deviation.

Abbreviations: BMI, body mass index; ASA classification, The American Society of Anesthesiologists Physical Status classification.

Table 2 Surgical Variables

Variable	Value
Operation time (min)	62.85±30.40
Intraoperative satisfaction (n)
Excellent	17 (54.9)
Good	9 (29.0)
Fair	5 (16.1)
Intraoperative VAS	3.41±1.26
Postoperative hospital stays (day)	2.90±1.48
Complications and adverse reactions (n)
Intraoperative neck pain	1
Transient lower limb numbness	3

Note: Values are presented as number (%) or mean ± standard deviation.

Abbreviation: VAS, visual analogue scale.

Table 3 Patient-Reported Outcomes Measures

Time Period	VAS-LP	ODI
Preoperative	5.93±2.80	67.51±16.93
3 Months Postoperative	1.87±1.02*	20.10±11.53*
6 Months Postoperative	1.61±0.62*	17.63±12.94*
12 Months Postoperative	1.54±0.72*	16.86±9.04*

Notes: *Compared to preoperatively, p < 0.001.

Abbreviations: VAS-LP, visual analogue scale for leg pain; ODI, Oswestry Disability Index.

Figure 2 Clinical outcomes based on the modified Macnab criteria at last follow-up.

Figure 3 Typical case: A 75-year-old female patient complained of neurogenic claudication and was diagnosed with L4-5 degenerative lumbar spinal stenosis. (A and B) Preoperative axial MR and CT images at L4-5. (C and D) Postoperative axial MR and CT images.

Abbreviations: MR, magnetic resonance; CT, computed tomography.